摘要
目的通过对维持性血液透析(maintenance hemodialysis,MHD)患者透析前、后血清N端脑钠肽(N-terminal pro brain natriuretic peptide,NT-proBNP)的变化与血压、超滤量、心胸比例、水肿指数以及低血容量指数的相关性分析,探讨NT-proBNP对MHD患者容量负荷的诊断价值。方法检测56例患者透析治疗前、后血清NT-proBNP的水平,对MHD患者NT-proBNP水平与血压、超滤量、水肿情况、透析过程中低血容量发生的次数以及心胸比例进行相关性分析。结果 MHD患者透析前、后血清NT-proBNP水平均显著高于非慢性肾脏病患者,差异均有统计学意义(均P<0.01),MHD患者透析后NT-proBNP水平较透析前明显下降(t=5.300,P<0.01),透析前后NT-proBNP的差值与脱水量之间呈明显的正相关(r=0.332,P<0.05)。MHD患者透析前血清NT-proBNP水平与血压、水肿指数和心胸比例呈正相关(均P<0.01),与低血容量发生次数呈负相关(r=-0.447,P<0.01)。MHD伴有高血压患者透析前血清NT-proBNP水平显著高于无高血压的透析患者(t=2.333,P<0.05)。血清NT-proBNP水平小于中位数MHD患者与大于中位数的MHD患者比较,收缩压明显偏低(t=2.437,P<0.01),临床低血容量发生率较高(x2=9.984,P<0.01),水肿发生率较低(x2=8.054,P<0.01)。根据NT-proBNP四分位数将MHD患者分为A、B、C、D4个亚组,4组患者心胸比例逐渐升高,其中A、B组之间差异无统计学意义(P>0.05),其他各组之间差异均有统计学意义(均P<0.05)。结论 MHD患者血清NT-proBNP水平显著升高,并且与血压、心胸比例、水肿以及低血容量发生次数密切相关。监测血清NT-proBNP水平对判断MHD患者的容量负荷,调整干体质量,减少急性低血容量并发症具有临床应用价值。
Objective By investigating the levels of NT-pro brain natriuretic peptide（BNP） before and after dialysisand in serum to explore its correlation with volume overload in patients on maintenance hemodialysis（MHD）.Methods 56 patients who were treated with MHD for at least 3 months before the study and in a stable clinic status were selected.Serum NT-proBNP level before and after dialysis were assayed,and the cardiothoracic ratio and blood pressure before the treatment were recorded.The times of hypovolemia in the process of 12 dialysis treatment was recorded,and the degree of edema was collected.The relationship between serum NT-proBNP level and dry weight in these patients was analyzed.Results The serum NT-proBNP level before and after dialysis of MHD patients were significantly higher than those of un-CKD groug（P0.01）,and the values in MHD group delined remarkably after each dialysis session.Serum NT-proBNP level was positively correlated with blood pressure,however,cardiothoracic ratio and the index of edema and was negatively correlated with the index of hypovolemia（P0.01）.Conclusion Higher serum NT-proBNP was frequently occurred in MHD patients,and closely related with blood pressure,cardiothoracic ratio,edema and blood volume.As a noninvasive and sensitive indicator,serum NT-proBNP may be used for evaluation of dry weight in time in MHD patients.
出处
《中国血液净化》
2011年第7期376-379,共4页
Chinese Journal of Blood Purification
关键词
血液透析
N末端脑钠肽
心胸比例
水肿
低血容量
Hemodialysis
N-terminal pro brain natriuretic peptide
Cardiothoracic ratio
Edema
Hypovolemia
